The Trustees have chosen the UnitedHealthcare Choice Plus plan to
provide you with quality medical care and CVS Caremark for prescription
drug benefits. Through UnitedHealthcare , you also get the convenience
and cost savings of the national Choice Plus provider network although
you have the freedom to visit any provider you'd like.

The
following pages contain a brief overview of Level I benefits, including
a summary of your life insurance, Accident Insurance and Disability
benefits. These benefits are described in Section 8: Life and Dismemberment
Insurance and WA&S. For Legal Services, refer to Section 9 for benefits
provided. Your Medical Benefits are described in greater detail later
in this section.

Benefit

You Pay

Notes

PPO

Non-PPO

Annual
Out-of-Pocket Maximum

$0

$5,000
per Person

$10,000
per Family

f your copayments to a non-participating
Choice Plus provider exceed the annual out-of-pocket
maximum, the Plan will increase your coverage for most services
from 80% to the full allowable amount for the rest of the calendar
year. Deductible, penalties, flat dollar copayments, infertility
copayments, and injectable drug copayments do not apply to the
annual out-of-pocket expenses.

Annual
Deductible applies to both network and non-network
services separately.

$50
per person, up to 2 members per family per calendar year

$375
per person, up to 2 members per familyper
calendar year

When
you visit network providers, you're covered at 100% of the allowable
amount for most services after you meet your calendar year deductible,
except for services with a specific dollar copayment.

Benefit

You Pay

Notes

PPO

Non-PPO
Deductible
Plus

Preventive
Office visits

$0
copayment

20%
of the allowance after deductible

Includes
medication visits for mental illness.

Specialists

$25 copayment

20% of the allowance after deductible

Emergency
room care

$100
copayment

$100
copayment deductible does not apply

Copayment
waived if you are admitted to the hospital within 24 hours. Coverage
for accidents and life-threatening emergencies only.

Ambulance
services

20%
of the allowance

20%
of the allowance.
This benefit does not accumulate toward the annual out-of-pocket
maximum deductible does not apply

Standard
coverage under all group health plans will include municipal ambulance
coverage for emergency transports. In addition to private ground
ambulances municipal ground ambulance will be subject to the same
contractual deductibles, copayments and coinsurance as private
ground ambulance services. Coverage is limited to a maximum of
$3,000 per occurrence for water and air ambulance.

The lab and x-ray facilities
of some participating hospitals may not be considered in-network
for all services. Call ahead or contact Customer Service at (866)527-9596
before you seek this kind of care.

Colonoscopies
and sigmoidoscopies

$0

20% of the allowance
after deductible

Physical
exams

$10
copayment

20% after deductible

Pre-marital
and pre-employment exams are not covered.

Pediatric
preventive services

$10
copayment

20% after deductible

Includes
routine physicals, lab work and immunizations.

No copayment will apply for wellness exams from birth to age 15
months.

Up
to 30 hours per member per calendar year for facility based or
office-based counseling.

Physical/occupational
therapy

$0
(see notes) after deductible

20%
of the allowance after deductible

With
a hospital-based therapist and within 30 days following a hospital
stay, home care program or ambulatory surgical procedure. Otherwise
covered at 80% after deductible. Coinsurance, when applicable,
does not accumulate toward the annual out-of-pocket maximum.

Durable
medical equipment (DME)

$0
after deductible

20%
of the allowance, this benefit does not accumulate toward the
annual out-of-pocket maximum after deductible

Must
be purchased at a participating DME vendor. Pharmacies do not
participate in the DME network.

Private
duty nursing

20%
of the allowance after deductible

20%
of the allowance after deductible

Preauthorization
is strongly recommended. This benefit does not accumulate toward
the annual out-of-pocket maximum.

Home
health care and hospice care

$0
after deductible

20%
of the allowance after deductible

Preauthorization
is strongly recommended. Includes physician, nurse and home
health aide visits.

Dental
Care

You Pay

Notes

Delta Dental PPO

Non-PPO

Annual
deductible

$0

$0

Annual
maximum

$2,500

$2,500

The
Plan will pay up to $2,500 per person for dental care each
calendar year.

Lifetime
maximum

N/A

N/A

There
is no cap on the amount the Plan will pay for dental care over
each covered person's lifetime.

Orthodontic
care maximum

$2,500

$2,500

The
Plan will pay up to $2,500 for orthodontic care for each covered
person.

The allowance is the amount that Choice Plus pays
to a network provider for a particular service, or the
amount Choice Plus will reimburse you if
you use an out-of-network provider. You may be required
to pay a percentage of the allowance (coinsurance) for
certain services.

No
one ever plans on getting sick or injured — but just in case — you should
be familiar with the variety of Level I medical benefits that the Teamsters
251 Health Services Plan offers you and your family.

The Trustees have selected the UnitedHealthcare’Choice Plus
to provide high quality and convenient coverage including doctor's
office visits, hospitalization and surgery, extended care, chemical
dependency and behavioral health benefits. UnitedHealthcare providers
accept a pre-negotiated rate (allowance) for all services. In most
cases you're only responsible for your coinsurance or a small copayment,
if applicable.

If you're eligible for Level I benefits,
you're covered by the UnitedHealthcare Choice Plus National network
of physicians.

Through the National network , personal physician
office visits are either $0/10 and specialist office visits
are just $25.

UnitedHealthcare offers unlimited days for most inpatient
hospitalization.

If you visit a provider who is not in the UnitedHealthcare
Choice Plus national network, UnitedHealthcare will generally
reimburse you at 80% of the allowed amount. You will be
responsible for paying the entire amount up front, and
any balance that the non-network provider charges above
the plan allowance, after you've met your annual deductible.

UnitedHealthcare has providers across the country so that you
can receive care no matter where you live, work or travel.

What
You Need To Do:

What is Coinsurance?

Coinsurance is a percentage of the allowance that
you must pay for certain services under this program. If the
allowance for a service is $100 and the Plan pays 80%, your
coinsurance is the remaining 20% — so you must pay $20 for
this service.

Check your provider directory, call 1 (866 527-9596), or visit
the Web site at www.myuhc.com to find a provider who participates
in the national network.

After you've received your medical care, the Choice Plus provider
will forward the claim for processing.

Out-of-Network
Service

You are not required to visit a doctor in the UnitedHealthcare Choice
Plus national network; however, if you are treated by an out-of-network
physician, you will pay more. You will be responsible for paying the
entire cost up front, and then submitting your claim to UnitedHealthcare.
They will generally reimburse you at 80% of the allowance for covered
services. You'll also be responsible for any amount that the out-of-network
provider charges above the UnitedHealthcare allowance, as well as any
applicable copayment. The example below shows the difference in out-of-pocket
costs when you visit a provider in the Choice Plus national network
or an out-of-network provider.

For example: Steven has to have surgery. UnitedHealthcare has
negotiated a discounted rate for services (the allowance) with national
network providers. The allowance for Steven's surgery is $500.

Choice
Plus national network provider

Non-Network Provider

The
UnitedHealthcare allowance for this surgery is $500

The
Non-Network provider charges $600 for this surgery

UnitedHealthcare pays 100% of the cost of the surgery. There is
no copayment for surgery. *

UnitedHealthcare pays 80% of the $500 allowance for this surgery
— $400 *

Steven
must pay his 20% coinsurance — $100

Steven
is billed for the difference between the allowance and the non-network
provider's charge — $100

The
Choice Plus national network doctor files Steven's claim for
him

Steven
must file his own claim.

Steven's
out-of-pocket cost — $0.

Steven's
out-of-pocket cost — $200.

*In
this example, the assumption is made that Steven has already met his
annual deductible.

Out-of-pocket
Maximum

The most you'll pay out of your own pocket for coinsurance each calendar
year is $5,000 per individual. If you have family coverage, any combination
of coinsurance payments that reaches $10,000 will meet the maximum.
Once you reach this maximum, UnitedHealthcare’ will reimburse
you for most eligible medical expenses at 100% of the allowance rather
than 80%.

What's
Not Covered

Services that are not medically necessary

Services covered by the government

Benefits available from other sources

Services or supplies mandated by laws in other states

Services provided by college /school health facilities

Services provided by facilities that haven't been approved
by UnitedHealthcare

Services performed by people/facilities who are not legally
qualified or licensed

Eye Exercises

Illegal drugs

Employment related injuries

Eyeglasses, routine eye exams, contact lenses, hearing aids
or dental care (these are covered separately by the Plan, but not
under the Choice Plus agreement)

Deductibles, copayments or coinsurance

This
is not a contract. A detailed list of exclusions and limitations
appears in your UnitedHealthcare Benefit Booklet.

Hospitalization and Surgery

UnitedHealthcare provides coverage for you and your eligible dependents
for hospitalization and surgery.

Hospitalization and Surgery are
covered in full once your annual deductible has been met
when you use a Choice Plus network provider. No copayment applies.

You must pay a $100 copayment for
medically necessary care in an emergency room. If you're admitted
to the hospital, this copayment will be waived.

Hospitalization
Benefits

If you or your dependent(s) require treatment as an inpatient in a
general or speciality hospital, your hospital stay is covered in full
after you have met your deductible for an unlimited number of days.
There are unlimited days for elective hospital stays in a specialty
hospital. If you are hospitalized at a non-network hospital, you will
be reimbursed at 80% of the allowance after you've met your deductible.

Preauthorization
Recommended

You are strongly recommended to have any elective hospital stays and
surgeries preauthorized. If you use a RI participating provider, your
doctor will preauthorize your hospitalization for you. If you use a
non-network provider or national network provider you must call
(866) 527-9596 for preauthorization. If you do not have an elective
hospital stay preauthorized, services may not be covered.

Covered
Hospital Expenses:

The
Choice Plus plan covers the following services if you are hospitalized:

other hospital services necessary for your treatment and
approved by UnitedHealthcare.

Emergency
Room Care

Medically
Necessary emergency room care is covered after you pay a $100 copayment.
This copayment will be waived if you are admitted to the hospital within
24 hours. Only medically necessary emergency room services are covered,
including treatment for accidents and life threatening illnesses.

Surgery

Out of Network Benefits

If a non-network surgeon performs your
surgery, you will be responsible for 20% of the cost after you've
satisfied your annual deductible. A non-participating provider
can bill you up to actual charge.

UnitedHealthcare will cover most surgical procedures in full after your
annual deductible has been met as long as:

the doctor is a Choice Plus national network provider

the operation is not experimental/investigational or cosmetic
in nature;

you have obtained preauthorization, if necessary;

the operation is performed in a hospital, ambulatory surgi-center,
doctor's office, or at home by a doctor; and

the doctor is licensed to perform the surgery.

Multiple
Surgeries

When multiple procedures are performed on the same day by the same
indivicual physician or other healthcare professional, reduction in
reimbursement for secondary and subsequent procedures with occur.
100% of the allowed amount will be applied to the primary procedure
50% of the allowed amount will be applied to the secondary procedure
50% of the allowed amount will be applied for all subsequent procedure

Anesthesia

This plan covers medically
necessary anesthesia services received from an anesthesiologist
when the services are related to a covered procedure. The allowance for
the anesthesia service includes the anesthesia care during the
procedure, time an anesthesiologist routinely spends with a patient
in the recovery room, time spent preparing the patient for surgery,
and for pre-operative consultations.

The allowance for
the surgical procedure includes local anesthesia.

What's
Not Covered

Services if you leave the hospital or are discharged late

Blood services

Charges for administrative services

Christian Scientist practitioners

Cosmetic procedures

Determination of post-operative fluid or electrolyte balance

Removal of growths or lesions (reported cauterizations or
electro fulguration methods used to remove growths)

This
is not a contract. A complete list of exclusions and limitations
appears in your UnitedHealthcare Benefit Booklet .

Wellness Benefits

Most wellness benefits, such as routine annual physicals,
annual gynecological exams and well-child office visits are
covered
with a $0 copayment when you use a Choice Plus national network Provider

Good
Health Benefit

Well-Child Benefits

The Plan covers your dependent children for physical exams and immunizations.
You are responsible for a $0 copayment per doctor's office visit.

The
following chart shows the number of covered physical examinations your
child may receive, based on age.

Age

Number of Physical Exams Covered

Birth
through 15 months

8

16
months through 35 months

3

36
months through 19 years

1 per year

Wellness Benefits

When
you visit a Choice Plus national network provider,
personal physician office visits are just $10. If you
visit a non-network provider for wellness benefits,
you must pay 20% of the Choice Plus allowance
and any amount your non-network provider charges above
the allowance, after you meet your deductible.

Well-Woman
Benefits

The Health Services Plan encourages women to have an annual wellness
exam. Women are eligible for an annual exam for a $0 copayment when
performed by a Choice Plus national network provider and a pap test
which is covered in full.

Women
are also eligible for one baseline mammogram between the ages of 35-39
and one every year at age 40 and after.

Woman's
Health and Cancer Rights Act of 1998

In
accordance with the Women's Health and Cancer Rights Act of 1998, this
Plan will provide the following coverage for a participant who is receiving
benefits in connection with a mastectomy and who elects breast reconstruction
surgery in connection with such mastectomy:

reconstruction of the breast on which the mastectomy has
been performed;

surgery and reconstruction of the other breast to produce
a symmetrical appearance; and

prostheses and physical complications for all stages of
the mastectomy, including lymphedemas.

Preventive
Physical Exams

Annual physical exams are covered as a regular personal physician
office visit for a $0 copayment when you visit a Choice Plus national
network provider.

What's
Not Covered

Premarital or pre-employment physicals

Weight loss programs/procedures

This
is not a contract. A complete list of exclusions and limitations
appears in your UnitedHealthcare Benefit Booklet.

Extended Care Benefits

If you or someone in your family requires extended care, such as Home
Health Care, Hospice Care, or Skilled Nursing Facility Care, UnitedHealthcare
will pay the full cost for most services, when you use a Choice Plus
national network provider.

It is strongly recommended that you receive preauthorization
before receiving extended care benefits. If your Extended
Care services are provided by a network provider or facility
that participates directly with UnitedHealthcare, the
provider will call to preauthorize your treatment for
you. If you visit non-participating providers or facilities,
we recommend that you call customer service to initiate
the preauthorization process before scheduling the service.

Preauthorized Hospice Care services are covered in full after
your annual deductible has been met and there is no copayment when
you use a Choice Plus national network PPO provider.

Non-Network Extended Care Benefits

If you use providers who do not participate in the
Choice Plus national PPO network, Choice Plus
will cover 80% of the allowable charge for covered services.
You will be responsible for the other 20% as well as any
amount the non-network provider charges over the allowable
amount, after you've satisfied your deductible.

What
You Need to Do:

If you obtain extended care benefits from a non-network provider
or facility, contact UnitedHealthcare Choice Plus at (866)527-9596
at least two days before you require care to receive preauthorization.

Home
Health Care

If you or one of your eligible dependents qualify to receive health
care at home, UnitedHealthcare will cover the services provided through
a hospital or approved community home health care program to treat
your condition. The following services are covered in full after your
annual deductible has been met when you use a Choice Plus national
network provider:

Visiting nurse services billed by a visiting nurse agency;
and

Services of a home health aide.

Home Infusion therapy services.

Private
Duty Nurses

Medically necessary services are covered when received in your home
as part of an approved home care program. You will be responsible for
20% of the allowable charge after your annual deductible has been met
for Private Duty Nurses. Refer to your UnitedHealthcare Summary Plan
Description for exclusions.

Hospice
Care

If
you have a terminal illness, you may be eligible for the following Hospice
Care benefits:

Services of a hospice coordinator billed by the hospice care
program;

Services of a visiting nurse when billed by a visiting nurse
agency; and

Services of a home health aide.

When Hospice Care is preauthorized and you use Choice Plus national
network providers, Hospice Care services are covered in full after
your annual deductible has been met and there is no copayment.

Skilled
Nursing Facility

Care
in a Skilled Nursing Facility is covered for you and your dependents
if preauthorization is obtained and:

The care can only be provided in a skilled nursing facility
where you are in inpatient.

What's
Not Covered

Homemaking services or services provided by relatives or members
of your household.

This
is not a contract. A complete list of exclusions and limitations
appears in your UnitedHealthcare Benefit Booklet.

Behavioral Health and Chemical Dependency

Through UnitedHealthcare, you and your eligible dependents
are eligible for treatment of behavioral health and chemical dependency.
Your level of coverage depends on whether you receive treatment as
an inpatient or as an outpatient, and whether you use a provider in
or out of the Choice Plus national network.Remember, for both inpatient
and out-of-network care, you must satisfy your deductible before UnitedHealthcare
will pay benefits.

It is strongly recommended that you
obtain preauthorization from the Behavioral Health/Chemical
Dependency Case Manager before you receive treatment.

You may receive outpatient treatment
for Behavioral Health and Chemical Dependency for a $15 copayment
per visit.

If you receive out-of-network treatment
call 1 (866)527-9596 to have a case manager preauthorize benefits.

How can I get
preauthorization for treatment?

If your provider participates in the UnitedHealthcare Choice
Plus. network, he or she will call the case manager for you.
If you seek care from a provider who does not participate
in the network you must call (866)527-9596 to have a case
manager preauthorize your treatment. If you fail to call,
you may be responsible for all charges deemed not to be medically
necessary.

Behavioral
Health Treatment

Inpatient

With preauthorization, your inpatient treatment is
covered in full after your annual deductible has been met for unlimited
days per calendar year when you use a provider in the Choice Plus national
network.

If you seek treatment for behavioral health outside
of the Choice Plus national network, you will be responsible for a
20% coinsurance, after you've met your deductible, as well as any amount
your non-network provider charges over the UnitedHealthcare allowance.

Outpatient

If you receive treatment for behavioral health from a Choice Plus
national network provider, you will be covered for up to 30 visits
per calendar year for a $15 copayment. For outpatient treatment from
a non-network provider, you will be responsible for 20% of the allowance
in addition to your copayment, after you've met your deductible, and
any amount over the allowance that the non-network provider charges.

Chemical
Dependency Treatment

Inpatient

UnitedHealthcare will pay for your inpatient rehabilitation for up
to 30 days per year after your annual deductible has been met. If you
need inpatient treatment for detoxification, you will be covered for
up to five admissions or 30 days per year, whichever comes first.

If
your inpatient treatment is provided by a non-network provider, you
must pay 20% of the cost after you've met your deductible, as well
as any amount your provider charges over the UnitedHealthcare allowance.

Outpatient

If
your treatment for chemical dependency is provided on an outpatient
basis, you will be covered for up to 30 hours per calendar year for
a $15 copayment.

What's
Not Covered

Marital counseling

Mental disorders and illnesses which, according to general
medical standards, cannot be effectively treated

Psychoanalysis for educational purposes

Recreation therapy, non-medical self-care, or self-help training

Smoking cessation

Chemical dependency treatment in your home or in a doctor's
office

This
is not a contract. A complete list of exclusions and limitations
appears in your UnitedHealthcare Benefit Booklet.

Prescription Drug Benefits

The
prescription drug benefit offers you and your family a convenient and
inexpensive way to receive your covered prescription medication. Your
responsible for your coinsurance.

You may choose to have your “non-maintenance” prescriptions
filled by mail, at a pharmacy that participates in the network, or
at a non-participating pharmacy. Your prescription drug program requires
that mail services or CVS/pharmacy be utilized for all maintenance
medications; however, you may receive two (2) fills (one original fill
plus one refill) at your retail pharmacy prior to being required to
use mail service or CVS/pharmacy. In order to determine if a medication
you are taking is a categorized as a “maintenance” medication
please call CVS Caremark Customer Service at 1-888-543-5940.

Your prescription drug plan is administered
through the CVS Caremark.

You pay coinsurance for prescription
drugs if you get them through a participating network pharmacy
or through the Direct Mail Service Program. You do not have
to meet a deductible to receive this benefit.

When you have your prescriptions
filled through the Mail Service Program, you may order your
refills by phone, mail or Internet.

What
You Need To Do

Find a participating Pharmacy near you. There is a comprehensive
list of pharmacies that are part of the network.

Take your CVS Caremark ID card to the pharmacy with you.

Pay the pharmacist your copayment when you pick up your prescription.
There are no claim forms to file, and you do not have to meet a deductible
to receive this benefit.

To use the Mail Service Program, call Customer Service at
1-888-543-5940 to request a form and an envelope.

Mail your prescription and your coinsurance payment with your
form in the envelope.

Generic Drugs Save You Money

Remember that if you ask your physician to prescribe
less expensive drug equivalents (generic drugs) you will pay less.

Covered
Prescription Drugs

The
following drugs are included as covered prescription drugs:

Most medications that require a physician's prescription by
federal law that are not available "over-the-counter;"

Needles and syringes when dispensed with insulin;

Oral contraceptives; and

Injectable drugs.

Participating
Pharmacies

When you fill a prescription at a pharmacy that participates
in the prescription drug network, you just present your CVS Caremark
ID card when you request your medication. You’ll pay a copayment
for the cost of the prescription.

More than 60,000 pharmacies participate
in the network, including major chains like CVS, Shaw's Supermarket/Star
Market, Stop and Shop, Target Pharmacy, and Walgreens as well as many
independent pharmacies. A list of participating
pharmacies is listed on the next couple of pages.

Non-Participating
Pharmacy

If
you have your prescriptions filled at a pharmacy that does not participate
in the network, you must pay the full amount of the prescription’s
cost at the time of purchase. You will be reimbursed according to the
CVS Caremark maximum allowance, not the retail cost, minus 20% copayment.
This means a higher out-of-pocket cost to you.

Mail Service
Convenience

After you've
placed your first order through the Mail Service program, you
can order your refills 24 hours a day, seven days a week, right
from home. You can pay your copayment by check, money order or
credit card, and shipping is free.

Mail
Service Prescription Drugs

The
Mail Service Program is required for you to receive “maintenance
drugs” that you require on an on-going basis. Examples of maintenance
drugs include those you take for high blood pressure, heart conditions
or diabetes. Because you know in advance that you will need this medication,
it’s easy to establish a routine of filling these prescriptions
by mail.

How
to use the Mail Service Program

First call CVS Caremark Direct at 888-543-5490 to request a
mail service form and envelope. At that time, find out how much
your copayment will be, so you can send payment with your order
or provide credit card information. You may also order prescriptions
on-line at www.pharmacare.com.

You
may order refills 24 hours a day, seven days a week by phone or mail.

What's
Not Covered

Over the counter drugs (even if prescribed)

Experimental drugs

Biological products for immunizations

Needles and syringes other than for use with insulin

Drugs used for cosmetic purposes

Viagra or any therapeutic equivalents

Medications that are administered while you are a patient
in a hospital, rest home, sanitarium, nursing home, home care program,
or other institution that provides prescription drugs as part of its
services or that operates a facility for dispensing prescription drugs

Drugs that do not have FDA approval or that have been placed
on notice of opportunity hearing status by the Federal DESI Commission

More than two treatments per lifetime of the following:

Smoking cessation drugs, Nicotine Transdermal Patch or

Nicotine Chewing Gum.

National and Regional
Pharmacy Chains in CVS Caremark National Network

UnitedHealthcare
reviews whether a health care service is medically necessary
to treat your illness or injury for the purpose of paying
your claims. If treatment or services that require a review
are not considered medically necessary, UnitedHealthcare
reserves the right to refuse payment.

Durable
Medical Equipment

UnitedHealthcare will cover Durable Medical Equipment
at 100% of the allowance after your annual deductible has been met
when you visit a Choice Plus national network provider. If you choose
to visit a non-participating provider a 20% coinsurance and deductible
will apply. The following equipment is covered, subject to medical
necessity review:

Rental or purchase, whichever is less expensive for wheelchairs,
hospital beds and other durable medical equipment used only
for medical treatment.

Replacement of equipment you own that is required due to a
change in your medical condition.

Therapeutic/molded shoes for the prevention of amputation
for the treatment of diabetes (two pairs of shoes or four individual
shoes per calendar year).

Group
health plans and health insurance issuers generally may not, under federal
law, restrict benefits for any hospital length of stay in connection
with childbirth for the mother or newborn child to less than 48 hours
following a vaginal delivery, or less than 96 hours following a cesarean
section. However, federal law generally does not prohibit the mother's
or newborn's attending provider, after consulting with the mother, from
discharging the mother or her newborn earlier than 48 hours (or 96 hours
as applicable). In any case, plans and issuers may not, under federal
law, require that a provider obtain authorization from the plan or issuer
for prescribing a length of stay not in excess of 48 hours (or 96 hours).

If
you and your physician decide to shorten your hospital stay, you will
be eligible for:

Up to two home care visits by a skilled, specially trained
or registered nurse for you and/or your infant, (any additional
visits must be reviewed for medical necessity); and

A pediatric office visit within 24 hours after discharge.

Additional days in the hospital may be covered if UnitedHealthcare
determines that additional days are medically necessary.

Newborn
Benefits

Your
newborn child is covered for services required to treat injury or sickness.
This includes the necessary care and treatment of medically diagnosed
congenital defects and birth abnormalities as well as routine well-baby
care (see Well-Child
Benefits).

Infertility
Treatment

UnitedHealthcare covers medically necessary services at 80% of the
allowance after your annual deductible has been met for the treatment
of infertility including donor gametes only if:

You are married;

You are unable to conceive or produce conception during a
one-year period; and

You are diagnosed as infertile.

What's
Not Covered

Massage therapy;

Aqua therapy;

Maintenance therapy;

Aromatherapy;

Therapies, procedures and services for the purpose of relieving
stress;

Pillows supplied by a chiropractor;

Foot care;

Freezing and storage of blood, sperm, gametes, embryo and
other specimens;

Gene therapy;

Genetic testing/counseling and amniocentesis;

Therapies/acupuncture and acupuncturist services;

Sex transformations and dysfunctions;

Surrogate parenting;

Reversal of voluntary sterilization; and

Infant formula.

This
is not a contract. A complete list of exclusions and limitations
appears in your UnitedHealthcare Benefit Booklet.